About 90% of my clinical practice is focused on caring for
the underserved:

The young,

The old,

Those suffering from chronic
medical illness, now unemployed,

Those without a home to go to at
the end of the day,

Those with a home but without any
furniture or food,

Racially diverse individuals,

Refugees,

LGBT individuals often afraid to
walk down the city streets that lead to our clinic,

& Medicare and Medicaid beneficiaries.

 

This list doesn’t even fully capture who might be labeled as
“underserved,” but reflects many vulnerable populations that turn to primary
care settings seeking behavioral health treatment. I work with patients in a
family medicine practice that serves over 20,000 individuals annually, most of
whom are from underserved backgrounds. These are families with low SES, who
frequently have experienced poly-trauma, chronic loss, and environmental
stressors. Often, they do not trust the medical system… and sometimes… when
they first meet me, I’m sure they don’t trust me… The evaluation of the
healthcare system as untrustworthy and unfair is not universally true, but it
is also not unjustified. Bias and discrimination exist – just watch one
political commentary these days and you’re bound to hear something about these
very populations and assumptions about individuals from such backgrounds.

But what do I know about these
things? I am privileged: my skin tone, my education, my SES, & my life
experience make me different from every patient who walks through my door.
There are other factors that distinguish us. And then there are commonalities:
the most obvious for many is gender or age, but there are my own family
experiences of aging and illness that provide me with a shared understanding. Some
patients ask to explore our differences immediately. Others wait, reflecting as
treatment ends that they weren’t “sure about” me but gave therapy a chance and
that they are grateful that they did. Others explore the subject when someone
throws privilege in their face: Questions are posed like, “can you believe this
white lady,” “that doctor doesn’t care about me, he’s just in it for the money,
right?” And suddenly, with these questions, we are processing that I too am a
white woman and doctor. How am I the
same as those who have acted from a space of privilege and how am I different?

 

Often, I cannot fathom what it is that these families have
been through. Their narratives are burdened by unending stressors that often
lead to pain and anger. They are estranged from family, have limited supports,
and the practicalities of their stressors are real. So…what do I have to offer?

 

I have learned over time that I can
very rarely fix the actual problems: the bed bugs, the lack of food, the
violence in a neighborhood. I am aware that these factors will cause continued suffering,
but there may not be the resources in my community to address the practical,
environmental needs of each individual. What I can give instead is empathy,
warmth, and compassion. I can provide a safe space that allows for processing
an acute stressor or remote hurt that has only furthered an individual’s
vulnerability. I can provide human contact that demonstrates that the patient
is someone valued and that even when they feel no one else cares, their
treatment team does. I can help them develop problem solving skills and work
with their team to identify community resources (when they exist) that will
help them overcome the limits that exist in their lives. I can simply be
present, listen, and hear their stories. I can advocate for change with them. I
can push myself to continuously learn about the value in what makes us each
different. And I can educate others to have better knowledge, tolerance, and
acceptance of differences.

 

I often end my days feeling drained, but then I remind
myself of how fortunate I am and turn to gratitude. Of course, there is gratitude
for my own upbringing and family, for the many gifts and opportunities I was granted…
but it is more than that. I am
grateful for patients’ wisdom and insight. As they battle obstacles in their
everyday lives, I am motivated to make change in my own and hopeful that I can
make even the slightest bit of difference in improving equality.

 

I leave work every day feeling lucky that families have had
enough faith, hope, and trust to show up at my door and share their stories
with me: that is privilege.

Lauren DeCaporale-Ryan, PhD is a Family Geropsychologist and Assistant Professor of Psychiatry, Medicine & Surgery at the University of Rochester Medical Center. In addition to clinical work, she provides coaching on patient-family centered communication skills and team-effectiveness to physicians and interprofessional teams in Internal Medicine and General Surgery. She is the Associate Track Director of the Primary Care Family Psychology Fellowship at URMC and serves as the Early Career Representative to CFHA’s Board of Directors.